Organization
BLUE WILLOW THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TANEKA TAYLOR LCSW (CLINICAL THERAPIST)
(217) 691-2760
Entity
Organization
Contact information
Practice address
2343 W WINONA ST, CHICAGO, IL 60625-1853
(217) 691-2760
Mailing address
2343 W WINONA ST APT 2E, CHICAGO, IL 60625-1853
(217) 691-2760
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
09/29/2021
Last updated
12/20/2021
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